title: Clinical effectiveness of percutaneous adhesiolysis and predictive factors of treatment efficacy in patients with lumbosacral spinal stenosis.
abstract: OBJECTIVE
  Patients with lumbosacral spinal stenosis (LSS) do not always obtain satisfactory pain relief from transforaminal epidural steroid injection (TFESI) because perineural/epidural adhesions prevent the spread of injectate into the epidural space. Percutaneous adhesiolysis (PA) can eliminate the deleterious effects of adhesion. This study was to evaluate the effectiveness of PA among patients with LSS refractory to TFESI and to ascertain the prognostic factors determining PA efficacy.
  
  
  METHODS
  Retrospective study.
  
  
  METHODS
  Spine hospital.
  
  
  METHODS
  Sixty-five patients with LSS refractory to TFESI who underwent PA with NaviCath® were reviewed.
  
  
  METHODS
  We recorded Numeric Rating Scale for back pain (NRS back) and leg pain (NRS leg), and Oswestry Disability Index (ODI), at pretreatment, 2 weeks, and 3 months after treatment. Successful pain relief and functional improvement were described as a 50% and 40% or more reduction in NRS and ODI, respectively. Clinical data and radiological findings were obtained to assess the possible predictive factors for PA efficacy.
  
  
  RESULTS
  Among the 65 patients, 45 (69.2%), 40 (61.5%), and 39 (60.0%) patients showed successful outcomes in NRS back, NRS leg, and ODI at 2 weeks, respectively. Among 63 patients who were followed up at 3 months, 34 (54.0%), 32 (50.8%), and 30 (47.6%) patients showed successful results, respectively. Spondylolisthesis, previous lumbar surgery, and foraminal stenosis were associated with a significantly higher proportion of unsuccessful result in NRS and ODI (%).
  
  
  CONCLUSIONS
  PA may be a useful treatment in patients with LSS refractory to TFESI and reduce the surgical requirement. Previous surgery, spondylolisthesis, and foraminal stenosis may be associated with poor prognosis.
authors.affiliation: Department of Physical Medicine and Rehabilitation, Wooridul Spine Hospital, Seoul, Korea.
authors.forename: Jung Hwan
authors.initials: JH
authors.lastname: Lee
authors.forename: Sang-Ho
authors.initials: SH
authors.lastname: Lee
mesh_terms: D002404:Catheterization / Q000379:methods*; D005260:Female; D006801:Humans; D008161:Lumbosacral Region; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D012189:Retrospective Studies; D013130:Spinal Stenosis / Q000628:therapy*; D000267:Tissue Adhesions / Q000628:therapy*; D016896:Treatment Outcome
keywords: Lumbosacral Spinal Stenosis; Numeric Rating Scale; Oswestry Disability Index; Percutaneous Adhesiolysis